Program Schedule

Impact of a New Practice Guideline on Antibiotic Use with Pediatric Tonsillectomy

Session: Oral Abstract Session: Advancing the Science of Antibiotic Stewardship
Saturday, October 11, 2014: 10:30 AM
Room: The Pennsylvania Convention Center: 107-AB

Tonsillectomy is the second most common pediatric surgery in the US with over 500,000 performed each year, and most patients historically receiving antibiotics. In 2010, the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) published a clinical practice guideline recommending against perioperative antibiotics for pediatric tonsillectomy.


We performed a quasi-experimental study to determine the impact of the AAO-HNS guideline on antibiotic prescribing and patient outcomes in children undergoing routine tonsillectomy within a large pediatric healthcare network. We included patients >1 and <19 years of age who underwent tonsillectomy between January 2009 and September 2012. The primary outcome was antibiotic administration on the day of surgery. Secondary outcomes included otolaryngology clinic encounters, emergency department encounters, hospital admission, and surgery for bleeding in the 30 days after surgery. Data were collected from a shared electronic health record and validated through manual chart review. We used an interrupted time series analysis (segmented logistic regression) with a non-equivalent dependent variable (tympanoplasty) to assess acute changes and differences in trends over time relative to guideline publication.


Of 9,265 tonsillectomies during the study period, 5359 met inclusion criteria. Immediately after guideline publication, perioperative antibiotic use dropped by 86.5% (p<0.001) and this was sustained throughout the study period (Figure 1). Rates of otolaryngology follow up, emergency room visits, or hospital admissions did not change acutely and trends were stable over time (Figure 2). There was a small but significant increase in surgeries for bleeding in the month immediately following the intervention (p=0.04), but trends between the pre and post intervention time periods were not different (p=0.39) (Figure 2).


The 2010 AAO-HNS guideline substantially decreased perioperative antibiotic use for pediatric tonsillectomy across a large, pediatric healthcare network. This change was associated with a small but statistically significant increase in surgeries for bleeding in the month following guideline publication.

Figure 1:

Description: Macintosh HD:Users:ensemilder:Dropbox:Research:Tonsillectomy antibiotics:Manuscript:ID Week 2014:Antibiotics Tonsillectomy pdf.pdf

Figure 2:

Description: Macintosh HD:Users:ensemilder:Dropbox:Research:Tonsillectomy antibiotics:Manuscript:ID Week 2014:Morbidity Outcomes Graph.pdf

Edmund Milder, MD, Pediatrics, Naval Medical Center San Diego, San Diego, CA, Mark Rizzi, MD, Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, PA, Knashawn Morales, ScD, Hospital of the University of Pennsylvania, Philadelphia, PA, Rachael Ross, MPH, The Children's Hospital of Philadelphia, Philadelphia, PA, Ebbing Lautenbach, MD, MPH, MSCE, University of Pennsylvania School of Medicine, Philadelphia, PA and Jeffrey S. Gerber, MD, PhD, Department of Pediatrics, Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA


E. Milder, None

M. Rizzi, None

K. Morales, None

R. Ross, None

E. Lautenbach, None

J. S. Gerber, None

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